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Emergency Transport of Stroke Suspects in a Rural State: Opportunities for Improvement
Time delay is the key obstacle for receiving successful stroke treatment. Alteplase therapy must start within 4.5 hours from stroke occurrence. Rapid transport to a Primary Stroke Center (PSC) or Acute Stroke Ready Hospital (ASRH) by the emergency medical system (EMS) paramedics is vital. We determined transport time and destination data for EMS identified and delivered stroke suspects in Arkansas during 2013. Our objective was to analyze transport time and the hospital qualification for stroke care across the state.
Source: The American Journal of Emergency Medicine - June 12, 2016 Category: Emergency Medicine Authors: Aliza T. Brown, Feifei Wei, William C. Culp, Greg Brown, Ryan Tyler, Appathurai Balamurugan, Nicolas Bianchi Tags: Brief Report Source Type: research

Emergency transport of stroke suspects in a rural state: opportunities for improvement
Time delay is the key obstacle for receiving successful stroke treatment. Alteplase therapy must start within 4.5 hours from stroke occurrence. Rapid transport to a primary stroke center (PSC) or acute stroke –ready hospital (ASRH) by the emergency medical system (EMS) paramedics is vital. We determined transport time and destination data for EMS-identified and -delivered stroke suspects in Arkansas during 2013. Our objective was to analyze transport time and the hospital qualification for stroke care across the state.
Source: The American Journal of Emergency Medicine - June 12, 2016 Category: Emergency Medicine Authors: Aliza T. Brown, Feifei Wei, William C. Culp, Greg Brown, Ryan Tyler, Appathurai Balamurugan, Nicolas Bianchi Tags: Brief Report Source Type: research

Are all stroke patients eligible for fast alteplase treatment? An analysis of unavoidable delays.
CONCLUSIONS: Up to 31% of patients have delays due to medical or eligibility-related causes that may be legitimate reasons for providing alteplase later than the benchmark time of 60 minutes. This article is protected by copyright. All rights reserved. PMID: 26824684 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - January 29, 2016 Category: Emergency Medicine Authors: Choi PM, Desai JA, Kashyap D, Stephenson C, Kamal N, Vogt S, Bohm V, Suddes M, Bugbee E, Hill MD, Demchuk AM, Smith EE Tags: Acad Emerg Med Source Type: research

Are all stroke patients eligible for fast alteplase treatment? An analysis of unavoidable delays
ConclusionsUp to 31% of patients have delays due to medical or eligibility‐related causes that may be legitimate reasons for providing alteplase later than the benchmark time of 60 minutes.This article is protected by copyright. All rights reserved.
Source: Academic Emergency Medicine - January 29, 2016 Category: Emergency Medicine Authors: Philip M C Choi, Jamsheed A Desai, Devika Kashyap, Caroline Stephenson, Noreen Kamal, Sheldon Vogt, Victoria Bohm, Michael Suddes, Erin Bugbee, Michael D Hill, Andrew M Demchuk, Eric E Smith Tags: Original Contribution Source Type: research

Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke
Ischemic stroke leads to a high burden of mortality and neurologic disability. The current standard of care is systemic alteplase, which has been shown to modestly improve functional outcomes, yet leaves much to be desired in terms of an effective treatment. Prior studies of intra-arterial alteplase and endovascular intervention have produced mixed results, potentially due to inappropriate patient selection criteria. The patients included in this study were individuals with proximal vessel occlusions in the anterior circulation.
Source: The Journal of Emergency Medicine - July 28, 2015 Category: Emergency Medicine Authors: Cecilia Sorensen Tags: Abstract Source Type: research

Effect of Treatment Delay, Age, and Stroke Severity on the Effects of Intravenous Thrombolysis with Alteplase for Acute Ischaemic Stroke: A Meta-analysis of Individual Patient Data from Randomized Trials
Ischemic stroke is a common medical condition that carries significant morbidity and mortality. Treatment with alteplase is a controversial modality that comes with significant risks and benefits. The authors of this study sought to analyze effects of age, time to treatment, and severity of stroke on stroke outcomes in patients treated with alteplase. A meta-analysis was performed, with a total of 6756 patients from nine randomized trials comparing alteplase with placebo or open control. Positive stroke outcomes were defined by this study as no significant disability at 3–6 months, as defined by a modified Rankin Score of 0 or 1.
Source: The Journal of Emergency Medicine - May 1, 2015 Category: Emergency Medicine Authors: Graham Ingalsbe Tags: Abstract Source Type: research

A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke
This study assessed whether intraarterial therapy plus usual care would be more effective than usual care alone in acute ischemic events.
Source: The Journal of Emergency Medicine - March 28, 2015 Category: Emergency Medicine Authors: Monique Lloyd Tags: Abstract Source Type: research

Ischemic Stroke Differential Diagnose: Spontaneous Spinal Epidural Hematoma can be fatal
Spontaneous Spinal Epidural Hematoma (SSEH) is rarely seen, it is the important reason for the spinal cord compression. Patients generally visit the doctor due to the acute pain in the neck and interscapular area. The male patient 58years old was admitted to the emergency service of our hospital with the sudden onset neck pain and followed by rapidly right hemiparesis He arrived at our hospital 120minutes after the onset of her symptoms with suspected acute stroke. We assessed for acute stroke performed clinical examinations necessary for intravenous thrombolytic treatment with alteplase, No abnormality was observed in his...
Source: The American Journal of Emergency Medicine - January 21, 2015 Category: Emergency Medicine Authors: Huseyin Buyukgol, M. Kemal Ilik, Faik Ilik Source Type: research

Newman's Notes: Alteplase for Ischemic Stroke (CME/CE)
(MedPage Today) -- Meta-analyses of alteplase for ischemic stroke debunked for high or unreported heterogeneity.
Source: MedPage Today Emergency Medicine - October 27, 2014 Category: Emergency Medicine Source Type: news

Spontaneous splenic rupture after thrombolysis for ischemic stroke
We present the first case of an atraumatic pathological splenic rupture following alteplase thrombolysis for ischemic stroke.
Source: The American Journal of Emergency Medicine - August 26, 2014 Category: Emergency Medicine Authors: Rachid Sirbou, Cindy Tissier, Yannick Bejot, Marc Freysz Tags: Case Report Source Type: research

Re-administration of Intravenous Alteplase in Acute Ischemic Stroke Patients: Case Series and Systematic Review
Background: Due to a high risk of recurrence of ischemic events, some patients may be candidates for re-administration of intravenous (IV) alteplase. Methods: We performed a single center review and performed a search on PubMed from January 1966 to April 2014 for cases of re-administration of alteplase. Favorable outcome was defined by a modified Rankin scale of 0-2 at discharge or at 1-3 months, improvement of ≥4 points within 24 hours in the National Institutes of Health Stroke Scale (NIHSS) score, or as a major improvement in the 72-hour NIHSS score.
Source: The American Journal of Emergency Medicine - July 30, 2014 Category: Emergency Medicine Authors: Adnan I. Qureshi, Ahmed A. Malik, Melissa Freese, Michelle Thompson, Asif A. Khan, M. Fareed K. Suri Source Type: research

Readministration of intravenous alteplase in acute ischemic stroke patients: case series and systematic review
Background: Because of a high risk of recurrence of ischemic events, some patients may be candidates for readministration of intravenous (IV) alteplase. Methods: We performed a single-center review and performed a search on PubMed from January 1966 to April 2014 for cases of readministration of alteplase. Favorable outcome was defined by a modified Rankin scale of 0 to 2 at discharge or at 1 to 3 months, improvement of greater than or equal to 4 points within 24 hours in the National Institutes of Health Stroke Scale score, or as a major improvement in the 72-hour National Institutes of Health Stroke Scale score.
Source: The American Journal of Emergency Medicine - July 30, 2014 Category: Emergency Medicine Authors: Adnan I. Qureshi, Ahmed A. Malik, Melissa Freese, Michelle J. Thompson, Asif A. Khan, M. Fareed K. Suri Tags: Case Report Source Type: research

Stroke Code. Intravenous Thrombolysis in Ischemic Stroke. Experience and Results
To analyze the performance and clinical outcomes of the implementation of a stroke code protocol in our field. Descriptive, observational study of all patients treated with intravenous thrombolysis with alteplase (rt-PA) over a 5-year period and analysis of the stroke code circuit performance, response time, clinical, neurological (National Institutes of Health Stroke Scale [NIHSS]), and functional status (modified Rankin scale [mRS]) after treatment and 3 months later.
Source: The Journal of Emergency Medicine - January 23, 2014 Category: Emergency Medicine Authors: D.R. Seguí, A.M. Destruels, J.G. Mora, M.C.B. Oliva, A.P. Guinjoan, F.X. Avilés Jurado, X. Ustrell Source Type: research

Simultaneous thrombosis of 2 vascular territories: is thrombolytic therapy a better option?
We have read with great interest the article by Akyuz and colleagues in the American Journal of Emergency Medicine and congratulate them for their observation. Their case exemplifies the concurrent occurrence of ST-segment elevation myocardial infarction (STEMI) and posterior circulation stroke that was eventually managed with thrombolytic therapy. Simultaneous thrombosis of 2 distant vascular territories is a rare and complicated clinical scenario. In these instances, there is usually an underlying cause linking both thrombotic events rather than being a mere coincidence. We have previously described the myocardial infarc...
Source: The American Journal of Emergency Medicine - July 1, 2013 Category: Emergency Medicine Authors: Hesham R. Omar, Devanand Mangar, Enrico M. Camporesi Tags: Correspondence Source Type: research

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